Questions About Sedation Protocols for Double-Balloon Enteroscopy

various levels of sedation ranging from conscious sedation to general anesthesia with participation of anesthesiologists. One of these studies reported only five sedation-related complications (2.3%) in the elderly (3 hypoxia cases and 2 aspiration pneumonias), while none were reported in the other studies. It is likely that because these studies focused on the overall safety of DBE and not only on the safety of sedation for DBE procedures, their sedation protocols were not described in detail. However, I think that it is very important to report not only the dose of sedatives, but also other sedation protocols, including pre-sedation patient assessment and periprocedural patient monitoring, in studies related to patient safety issues during any type of endoscopic procedure. Although little is known regarding the benefits of implementing a welldesigned sedation protocol, I hope the authors will share further details on their sedation protocols. For example, how they evaluated the DBE candidates before the procedure, how they monitored patients during/after the procedure, differences in endoscopic sedation protocols between DBE and other endoscopic procedures, and the need for a more individualized approach in the elderly.